HIV-1 Drug Resistance in Children and Implications for Pediatric Treatment Strategies: A Systematic Review and Meta-analysis

Joseph Fokam, Laboratory of Virology, Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon.
Aude Christelle Ka'e, Laboratory of Virology, Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon.
Bouba Yagai, Laboratory of Virology, Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon.
Maria Mercedes Santoro, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy.
Judith Kose Otieno, Africa Centres for Disease Prevention and Control, Addis Ababa, Ethiopia.
Natella Rakhmanina, Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA.
Collins Ambe Chenwi, Laboratory of Virology, Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon.
Alex Durand Nka, Laboratory of Virology, Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon.
Ezechiel Ngoufack Jagni Semengue, Laboratory of Virology, Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon.
Davy-Hyacinthe Gouissi, Laboratory of Virology, Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon.
Willy Leroi Togna, Laboratory of Virology, Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon.
Nelly Kamgaing, Laboratory of Virology, Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon.
Tetang Suzie, Department of Pediatrics, Essos Hospital Centre, Yaoundé, Cameroon.
Desire Takou, Laboratory of Virology, Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon.
Georges Teto, Laboratory of Virology, Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon.
Tatiana Tekoh, Laboratory of Virology, Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon.
Jeremiah Efakika Gabisa, Laboratory of Virology, Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon.
Audrey Nayang Mundo, Laboratory of Virology, Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon.
Lum Forgwei, Laboratory of Virology, Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon.
Naomi-Karell Etame, Laboratory of Virology, Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon.
Aurelie Minelle Kengni Ngueko, Laboratory of Virology, Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon.
Michel Carlos Tommo Tchouaket, Laboratory of Virology, Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon.
Boris Tchounga, Elizabeth Glaser Pediatric AIDS Foundation, Country Office, Douala, Cameroon.
Patrice Tchendjou, Elizabeth Glaser Pediatric AIDS Foundation, Country Office, Douala, Cameroon.
Joelle Nounouce Bouba Pamen, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
Rogers Ajeh Awoh, Faculty of Health Sciences, University of Buea, Buea, Cameroon.
Gregory-Edie Halle-Ekane, Faculty of Health Sciences, University of Buea, Buea, Cameroon.
Giulia Cappelli, Laboratory of Virology, Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon.
Alexis Ndjolo, Laboratory of Virology, Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon.
Francesca Ceccherini-Silberstein, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy.
Vittorio Colizzi, Laboratory of Virology, Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon.
Jean Kaseya, Africa Centres for Disease Prevention and Control, Addis Ababa, Ethiopia.

Document Type

Journal Article

Publication Date

7-1-2025

Journal

Open forum infectious diseases

Volume

12

Issue

7

DOI

10.1093/ofid/ofaf378

Keywords

ART; children; systematic review; “acquired drug resistance”; “pretreatment drug resistance”

Abstract

INTRODUCTION: Failure in the prevention of mother-to-child HIV transmission (PMTCT) and pediatric treatment challenges led to pretreatment drug resistance (PDR) and acquired drug resistance (ADR) in children with HIV (CWHIV). METHOD: Interventional and observational data published between 2010 and 2024 on PDR and ADR in CWHIV were included and analyzed by random effects models. RESULTS: Overall, 72 studies encompassing 9973 children were included. The prevalence (95% CI) of PDR was 32.48% (26.08-39.21), and high among those who failed PMTCT prophylaxis (43.23% [32.94-53.82]) versus those without PMTCT-intervention (P < .01) and driven by nonnucleoside reverse transcriptase inhibitors (NNRTI) mutations (28.38% [18.74-39.08]; P = .013). The prevalence of ADR was 61.43% (49.82-72.45), driven by NNRTI-mutations (65.17% [53.95-75.63]; P < .001). INSTI-ADR was low (5.53% [2.49-9.53]) but emerging. CONCLUSION: There are high burdens of PDR and ADR among CWHIV, suggesting the need to phase out pediatric NNRTIs used for either PMTCT or treatment. Emerging INSTI resistance among CWHIV highlights the relevance of drug-resistance surveillance strategies. PROSPERO REGISTRATION NO: CRD42023470034.

Department

Pediatrics

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